公立医院院长职业化评价指标的研究

目的:探讨科学、实用的公立医院院长评价指标,为建立院长职业化评价标准提供参考.方法:编制专用调查表和网络调查程序,通过江苏卫生行政和行业管理机构对省内部分卫生机构行政人员、医务人员及就诊病人和病人家属进行网络调查.调查内容包括6项一级指标和23个细化指标,由接受调查人员确认评价指标的必要性,并按总分100分对指标权重赋值,运用描述分析和卡方检验等方法对院长职业化评价指标认同度和指标权重进行分析.结果:共获取有效问卷1511份.各类人员对院长职业化评价指标总体认同度依次是个人品格/性格特征(88.6％)、专职化行为(87.2％)、专业化教育(75.6％)、相关经历(72.5％)、学历学位(63.9％)、技术职称(56.6％).对指标权重由高到低及其分值是个人品格/性格特征30.92分、相关经历22.99分、专职化行为19.18分、专业化教育12.78分、技术职称7.17分和学历学位6.96分.结论:制定院长职业化评价指标,建议以"领导者品格"、"专职化行为"、"专业化教育"和工作中"最优化业绩"为必备条件,同时注重指标的细化、量化、可操作性.     

综合评价模型在中医医院院长职业化程度定量分析中的应用

目的:通过对中医医院院长职业化程度评价模型的应用,了解中医医院院长的职业化程度与原因,为加快院长职业化程度提供参考。方法:对样本医院的院长(正职)进行深度访谈,利用按层次分析法(AHP)原理所建立的院长职业化评价模型对访谈结果进行定量评价与分析。结果:①综合评价模型具有客观性、综合性,而且简便、实用,能将定量的评价结果用于不同院长间的比较分析;②中医医院院长的职业化程度偏低;③中医医院院长职业化与院长绩效考核主体缺位和内容缺失、卫生管理职称缺失和卫生管理培训尚未制度化有很大关系。     

院长职业化是公立医院经营管理的关键

<正>2009年,《中共中央国务院关于深化医药卫生体制改革的意见》(中发〔2009〕6号)中针对医院管理者提出要"规范医院管理者的任职条件,逐步形成一支职业化、专业化的医疗机构管理队伍"。所谓医院院长职业化、专业化,是指通过医院管理专业的教育或培训,使医院院长具备医院管理专业的知识与技能,达到医院院长职业化管理的专业化、专职化、制度化[1]。1国外医院的职业化管理模式     

中医医院院长职业化程度及其影响因素分析

目的 了解中医医院院长的职业化程度及其影响因素，为决策者提供依据。方法 对样本中医医院院长进行深度访谈。结果 中医医院院长职业化程度良莠不齐，大多数院长职业化程度有待提高。导致职业化程度低的主要因素有院长绩效考核主体缺位和内容缺失、医院管理体制和干部任免任期制度以及卫生管理职称缺乏。建议 卫生主管部门积极协调政府有关部门，尽快出台卫生管理职称系列、院长的任职资格制度、卫生管理干部专职化制度等政策；加快研究和出台院长的绩效考核办法，加强在岗院长的管理知识培训，强化管理理念，推进职业化进程。     

卫生管理队伍职业化探究

卫生管理干部职业化是《中共中央、国务院关于卫生改革与发展》中提出的具有重大战略意义和深远历史意义的指导方针。北京地区的卫生管理干部大多数是由卫校专业技术岗位转做卫生管理工作,没有或很少接受管理科学知识系统培训。在阐述卫生管理队伍职业化的概念后提出其涵盖的６个方面：工作专职化、职位序列化、知识“Ｔ”型化、能力专业化、意识现代化、配置方式多样化。从资源和生产力构成两个方面论述了卫生管理干部职业化的意义     

公立医院院长职业化的现状与思考——以九江、株洲和武汉为例

目的以九江、株洲和武汉三市为例,分析我国公立医院院长职业化现状和问题。方莹定量和定性相结合,问卷调查44家医院160名院长,访谈10位卫生管理知情人,对院长的教育和专业情况、选拔方式和专职情况进行描述性分析。结果院长学历较高但以学医为主：绝大多数存在一肩多挑的现象,专职程度较差;半数以上院长由上级委派．公开招聘虽被看好但难以实施。结论我国公立医院院长职业化程度较低,应从卫生管理教育、选拔任用、绩效考核与和薪酬分配等方面加快改革。     

中医医院院长职业化程度对运营状况与病人反应性影响研究

目的:探讨院长职业化程度对医院运营情况及病人反应性的影响,为医院的发展提供参考意见。方法:历史数据分析法、问卷调查法和深度访谈法;结果:院长职业化程度与中医医院运营状况之间有相关性,相关系数r=0.582,院长职业化程度越高,医院运营状况越好;不同院长职业化程度的医院门诊反应性有区别,主要表现在"就医环境"、"及时性"和"选择性"3个方面,院长职业化程度越高,门诊反应性越好;对住院反应性没有明显的影响。建议:加快医院院长的职业化管理进程,提高院长职业化程度也是提高医院绩效的一条重要途径。     

医院院长职业化和专业化建设现状及推进策略

本文采用自填式问卷调查和典型调查相结合的方式对17个公立医院改革国家级联系试点城市的全部二、三级公立医院（其中北京市和上海市为市级公立医院）正副院长、正副书记进行了问卷调查。研究得出医院院长职业化和专业化建设的现状和问题是：院长多为医学专业背景;多数人不愿放弃临床专业;“医而优则仕”的选拔方式;管理者职能与所有者权力混淆;对院长的绩效考核和激励刚起步;院长职业化培训有提高的空间;院长职业化人才市场尚未形成。通过对现状和问题的分析,得出院长职业化建设推进策略为：促进院长的管理专业化建设;改革干部人事制度,建立院长的公开选拔机制;完善院长的绩效考核体系和激励约束机制;制定院长职业化的相关法律法规。     

公立医院院长职业化意愿及能力与培训时间相关研究

目的 了解四川省公立医院院长管理培训现状,探讨院长职业化认知及意愿、岗位能力与管理培训时间的相关关系。方法 对四川省二级及以上公立医院的1620名院长、副院长进行问卷调查,运用SPSS19.0进行统计分析。结果 (1)院长参加培训时间较短,累计培训时间超过3个月的仅占43.3%;(2)院长对职业化的了解程度(r=0.243,P<0.001)、担任职业化院长的意愿(r=0.088,P<0.001)与管理培训时间呈正相关;(3)院长的医院规划与经营能力(r=0.174,P<0.001)、领导艺术和魅力(r=0.166,P<0.001)等岗位能力与管理培训时间呈正相关。结论 医院管理培训是提高职业化认知水平、提升院长岗位能力的有效途径,要重视医院管理培训、完善培训制度和管理办法。     

建设医院职业化管理队伍对策探究

通过分析当前医院管理人员现状，提出医院职业化管理队伍的专职化、专业化、知识化、法制化。     

中国感染管理医师与护士工作模式设想的调查与探讨

目的 探讨中国感染管理医师和护士的工作模式.方法 对全国不同级别医院的医院管理者和感染管理科主任对感染管理医师和护士工作模式的设想进行抽样调查,调查资料采用SPSS11.5进行统计分析.结果 医院管理者和感染管理科主任对感染管理医师和护士设想的工作模式绝大多数为A模式,设想为B模式和C模式的总和约为10%.结论 医院管理者和感染管理科主任对感染管理医师和护士的工作模式的设想一致.     

医院院长管理素质测评标准体系的构建

我们综合应用文献查阅、专家访谈和问卷调查等方法确定了医院院长从事管理工作所必需的素质要求,共计7个测评项目36个测评指标。将获取的测评项目和测评指标编制成利克特量表后发放给有关专家,对结果进行统计分析得到测评指标的权重,从而初步构建了医院院长管理素质测评标准体系。     

National commission meets the grass roots: concerns of program directors in allied health education

An informal, open-ended survey was conducted by the National Commission on Allied Health Education for the purpose of learning what the directors of allied health programs in colleges and universities regard as the major problems facing allied health today and the major issues for the near future. The concerns of the respondents were found to cluster in 11 major areas: (1) definition (identity), (2) credentialing, (3) funding, (4) roles of educational settings, (5) clinical affiliations, (6) curriculum, (7) continuing education, (8) students, (9) faculty and administration, (10) delivery systems and consumer needs and (11) research and information needs. Even though consensus on problems was remarkable, there was no such general agreement on solutions. This initial "idea search" proved useful to the Commission in defining topic areas for documentation studies and in underscoring the necessity of looking for solutions.     

A study by the Delphi technique of expected competencies of public health nurses working in government organizations

PURPOSE: The purpose of this study was to clarify, using the Delphi technique and by the consensus of Experts, the expected competencies of Public Health Nurses (PHNs) working in government organizations according to their number of years' experience. METHODS: Experts were nurses who had a PHN license in academic, administration and service areas. The criteria for selecting are as follows: Academic: professors of community nursing department, in nursing college. Administration: chief PHNs working in prefectural government organization, with the role of supervising and controlling PHNs. Service: recommended by each administration Expert and fulfilling all the following 3 points; (1) PHN experience of 10 years or more in a government organization, (2) a supervisory position over at least one junior PHN, and (3) an effective practical record as a PHN. 209 Experts who were chosen by the specified criteria were approached for their participation. At Round 1, Experts were asked to list competencies important for PHN under 3 headings: knowledge, skills and attitudes. From the response in Round 1, competency items were categorized. A list was obtained and used in Round 2, when Experts were asked to select and rate the importance of competencies for 4 ranges of PHN years of experience. At Round 2, these competencies were analyzed on the basis of importance. At Round 3, Experts were asked whether they agree or not with the results of Round 2. The criterion for consensus was set as an agreement rate of 90%. RESULTS: Of the total, 63 agreed to participate; 14 in the academic, 23 in the administration and 26 in the service area. Response were turned 63 from all at Round 1, 52 at Round 2 and 44 at Round 3. The result clarified the expected competencies into 47 items and 7 categories related to their importance in the experience year ranges. The 7 categories were: Conducting nursing processes; Conducting community health activities; Providing health care; Management; Information application; Human relations; and Personal characteristics. The very important competencies PHNs should have were regarded as follows: (1) At 1-3 years' experience, PHNs should have 2 categories (2) At 4-10 years, they should have the 5 categories (3) At 11-20 years they should have all 7 categories (4) At 21 or more years they should have at least 6 categories. At all levels PHNs were required to have the 2 categories of Providing health care and Personal characteristics. CONCLUSIONS: It was expected as PHNs gain experience they should obtain wider and more faranding competencies stepwise, from basic nursing care to community care, and on to administration.     

The interdisciplinary model of hospital administration: do health professionals and managers look at it in the same way?

BACKGROUND: To assess health practitioners' views on the issue of hospital administration and explore possible conflicts. METHODS: Questionnaire-based, multi-stage cluster sampling technique was used as the design,in which 124 doctors, 154 certified nurses and 15 hospital managers participated. RESULTS: Only 39% of doctors and 51% of nurses were aware of the manager's basic degree and 70% of them considered it inadequate. Health sciences were chosen as the best basic degree for effective management by 65% of health practitioners. Moreover, 74% of doctors and 96% of nurses believed that an interdisciplinary board of directors, with the manager acting as a chairman could be the ideal administrative model. Even though this model was the current system in the interviewed hospitals, most health practitioners (87%) considered it ineffective. With regard to the acceptance of the manager as authority in the hospital, 76% of the doctors believed that there were related problems (47% considered the manager as an outsider to the health sector), whereas only 45% of the managers admitted such problems. Trainees showed a less tolerant attitude towards managerial administration in comparison to specialists. CONCLUSION: Most health professionals believe that hospital administration is ineffective. The interdisciplinary model, with a manager having both health sciences and economics degrees and exercising his/her role with flexibility and taking the widest consent of health professionals may improve the very low rates of acceptance and perceived efficacy. Trainees and nurses seem to often have different views, suggesting the importance of their participation in the administrative model.     

液基细胞薄层涂片阴道镜对早期子宫颈癌筛查临床与流调应用研究

目的 :探讨液基细胞薄层涂片 ( TCT)、阴道镜合用对早期子宫颈癌及癌前病变筛查的可行性。方法 :以广东省东莞市长安医院妇科就诊的患者作为筛查人群 ,选择从未进行 TCT、阴道镜及 HPV等检查 ,且均有性生活和非孕期妇女 (年龄不限 )共计 2 5 14例 ,其中本地户籍 12 9例 ( 5 .1% ) ,外地户籍 2 385例 ( 94 .9% )。以病理组织学为金标准 ,结合 HPV- DNA分子生物学诊断技术 ,评价 TCT、阴道镜检查的诊断价值。结果 :该人群现患率 :HSIL (高度鳞状上皮内瘤变 )为 1.4 % ( 34/2 5 14 ) ;SCC(鳞状细胞癌 )为 0 .3% ( 7/ 2 5 14 ) ;平均年龄分别为 33.6和 38.1;人群平均初次性交年龄、性伴数、孕次、产次分别为 2 1.5、 3.2、 4 .8、 2 .3;从事宾馆娱乐美容业占 6 7.3%、家庭妇女占 12 .0 % ,3种方法的敏感度、特异度、阳性预测值、阴性预测值分别为 HPV (阳性≥ 1.0 pg/ ml) ( 0 .96 7,0 .84 4 ,0 .2 2 0 ,0 .998) ;TCT (≥ L SIL 为阳性 ) ( 0 .86 1,0 .95 9,0 .5 77,0 .993) ;阴道镜检查 (≥ CIN 为阳性 ) ( 0 .898,0 .6 89,0 .134,0 .993)。结论 :1该患病人群符合子宫颈癌及癌前病变的流行病学特点 ,因此 ,在开放地区开展早期子宫颈癌及癌前病变筛查有着重要的现实意义。 2 TCT制片效果优良 ,敏感度和特异?     

Genetic diversity of pneumococcal surface protein A of Streptococcus pneumoniae meningitis in German children

Pneumococcal surface protein A (PspA) is a possible candidate for the development of a pneumococcal vaccine that has the potential to offer a broad range of protection. PspA genes of pneumococcal meningitis isolates (n=40) isolated as part of an ongoing population-based nation-wide surveillance program on invasive pneumococcal disease in children in Germany were analyzed to expand our knowledge on the distribution of PspA families of this important vaccine candidate in Germany. The serotype distribution of the strains was as follows: serotype 4 (n=3), 6B (5), 9V (2), 14 (8), 18C (6), 19F (5), 23F (6), and 7F (5). The pspA genes of these strains could be assigned to 2 families containing 20 pneumococcal strains each. Family I could be subdivided into 2 clades with 17 strains in clade 1 and 3 strains in clade 2, and family II could be subdivided into 3 subgroups (clades 3-5) containing 16, 3, and 1 strain, respectively. Pneumococcal serotypes were distributed evenly over all clades and families. Interestingly, the distribution of the PspA gene families in Germany was seen to differ slightly that found in other countries.     

The influence of lifestyle and night-shift work on sleep problems among female hospital nurses in Japan

STUDY OBJECTIVE: In this study, by conducting a questionnaire survey, we aimed to clarify the situation regarding sleep disorders in female hospital nurses and their relation with night-shift work and lifestyle. METHODS: The subjects were female nurses working at 5 hospitals, each with more than 400 beds. The survey was carried out in July 2000. The questionnaire contained six items concerning sleep quality from the Pittsburgh Sleep Quality Index (PSQI), two new items on sleep drafted by ourselves, and some questions on lifestyle and shift-work status. RESULTS: Among all female nurses, statistically significant differences were observed between those working and those not working night shifts for 7 items regarding sleep (P < 0.05). Significant correlations were observed between sleep disorders and the following factors: (1) working night shift, (2) having anxiety or stress, (3) getting less than 6 hours of sleep, (4) working in cities, (5) having children, and (6) bathing more than 1 hour before going to bed. In addition, significant correlations were observed between getting less than 6 hours of sleep and the following factors: (1) being 40 years of age or older, (2) working in cities, and (3) having anxiety or stress. CONCLUSIONS: The results of this study suggest that sleep problems among nurses are associated not only with night-shift work but also with lifestyle. They also suggest that nurses who work night shifts, especially in Tokyo, should try to get sufficient hours of sleep to ensure good quality of sleep.     

彩色多普勒超声评定下肢穿静脉功能不全的诊断效能研究

目的:探讨彩色多普勒超声评定下肢穿静脉功能不全的诊断效能。方法:选取医院收治的107例下肢浅静脉曲张患者将其作为观察组(根据静脉曲张分级标准再分为C1~C2级组、C3~C4级组和C5~C6级组),同期选择20名健康体检者作为健康对照组。所有受检者均完成多普勒超声检查,观察下肢静脉曲张情况。将超声诊断结果与X射线造影结果进行对照,分析超声对功能不全的穿静脉形态及功能的诊断效能。结果:(1)C5~C6级患者大隐静脉内径宽于C1~C2级、C3~C4级患者,LSD-t检验其差异有统计学意义(P<0.05);(2)不同分级患者大隐静脉及股静脉反流程度比较差异无统计学意义;(3)C5~C6级患者患肢穿静脉内径均宽于C1~C2级、C3~C4级患者,LSD-t检验其差异有统计学意义(P<0.05),C5-C6级组患者穿静脉瓣膜反流所占比例高于C1~C2级组、C3~C4级组患者,LSDt检验其差异有统计学意义(P<0.05);(4)超声诊断功能不全穿静脉灵敏度、特异度及符合率分别为86.67%、82.35%和85.11%;(5)下肢静脉曲张患者穿静脉开放数目与肢体远端挤压试验反流、穿静脉内径均呈正相关(r=0.276,r=0.367;P<0.05);穿静脉瓣膜功能与大隐静脉瓣膜功能则呈负相关(r=-0.244,P<0.05);大隐静脉瓣膜功能不全患者反流速度与深静脉瓣膜功能不全呈正相关(r=0.295,P<0.05)。结论:超声检查对下肢功能不全的穿静脉诊断与X射线造影一致度高,可作为一种灵敏度及特异度都很高的诊断穿静脉功能不全的检查方法。